Lazy Eye Surgery in Children - a Survival Guide

Lazy eye is the common term for strabismus or amblyopia. Lazy eye results from misalignment or lack of coordination of the eye muscles. When patching, eye drops and corrective glasses do not correct the problem, surgery is the next step.

With a little planning, lazy eye surgery is less stressful for the entire family. As an adult who had lazy eye surgery as a child and mother of a child who has also had surgery for amblyopia, I can provide a few tips to make it easier to survive strabismus surgery.

• The older the child, the longer the recovery time. The greater the number of diopters, the longer the recovery time. Plan adequate time to recover before expecting children to return to school or childcare. Ideally, arrange at least several days of uninterrupted recovery time. Planning surgery right before a holiday weekend or the end of school reduces the amount of time missed.
• Have a doctor’s note excusing your child from Physical Education (PE) for a week or more after surgery. Greater age and severity of divergence will result in a longer time period before depth perception is fully recovered.
• Discuss with your child the surgery’s effect in an age appropriate manner. They need to understand that they will be put to sleep, their eyes will be fixed and that family will be waiting for them upon recovery. Do not let siblings describe horror stories. Avoid undue anxiety by failing to discuss what will be done. However, graphic detail of the procedure is neither necessary nor helpful.

• Arrange for adequate pain management. Over the counter pain relievers can be given in alternating doses for discomfort. For older children and severe cases, request stronger prescription pain relievers for your child for the first few days.
• Have the doctor’s emergency phone number before leaving the pre-operative consultation. Dealing with a post-operative infection or severe pain in the middle of the night is not the time to be left calling a doctor’s after hours phone line to listen for a contact number to call in hopes of leaving a message for the doctor.
• Ensure that your child does not have to negotiate steps or climb ladders to get into bed after the eye surgery. If necessary, let them sleep on a pile of blankets and stuffed animals on the floor.
• Plan activities your child can do with limited or no vision. Younger children can guess the identity of a stuffed animal by feeling it. Older children can have friends come to talk. “Guess this song” based on hearing small song samples or attempting to guess who originated a quote can occupy older children and teenagers. Spelling bees, verbal vocabulary quizzes, trivia contests and oral reciting of math facts can also pass the time while building up academic skills.
• Don’t forget your other children. If you are home with one child recovering from surgery, arrange for someone else to pick up your other children from school. Consider asking family members or neighbors to help shuttle unaffected children to activities or help with homework.

• Plan meals that do not require silverware for your child. Mini corn dogs, crust-less sandwiches, French Fries, cheese sticks and slices of fruit work well for older children. Toddlers can eat sandwiches or pasta intended to be eaten with the fingers.
• Expect behavioral regression in elementary aged and younger children. Given the discomfort and blurry world, a child may retreat to sucking their thumb for a few nights.
• Plan for accidents. A toilet trained child may have accidents when faced with discomfort and confusion. Recognize that even older children may not wake up in time to get to the bathroom when recovering from anesthesia or when taking pain killers.
• Do not minimize your child’s complaints of pain, blurriness, possible blindness or confusion. Empathize, evaluate, and then take appropriate action.

Older children can expect double vision for days or even weeks after the surgery, and they may experience split second blurriness after they blink as their eyes try to focus after each blink.

If there is excessive pain, blurred vision or eye strain beyond the first days of the surgery, consult with the surgeon or your eye doctor.

After the eye surgery, the lazy eye should be corrected. However, this does not mean that the condition may not reappear in the later years as the child grows.